Contemporary Anesthetic Evaluation and Management for Electroconvulsive Therapy.

Electroconvulsive therapy (ECT) is a medical treatment most often used in patients with severe major depression that has not responded to other treatments. ECT is also indicated for patients with other severe psychiatric conditions, including bipolar disorder, schizophrenia, schizoaffective disorders, catatonia, and neuroleptic malignant syndrome. Contemporary "modified ECT" involves inducing general anesthesia with neuromuscular blockade before inducing the therapeutic seizure.

Motor-sparing nerve blocks for total knee replacement: A scoping review.

Study Objective: This scoping review investigates the optimal combination of motor-sparing analgesic interventions for patients undergoing total knee replacement (TKR).

Design: Scoping review.

Intervention: MEDLINE, EMBASE and CINAHL databases were searched (inception-last week of May 2020).

Lower extremity regional anesthesia: essentials of our current understanding.

The advent of ultrasound guidance has led to a renewed interest in regional anesthesia of the lower limb. In keeping with the American Society of Regional Anesthesia and Pain Medicine's ongoing commitment to provide intensive evidence-based education, this article presents a complete update of the 2005 comprehensive review on lower extremity peripheral nerve blocks. The current review article strives to (1) summarize the pertinent anatomy of the lumbar and sacral plexuses, (2) discuss the optimal approaches and techniques for lower limb regional anesthesia, (3) present evidence to guide the selection of pharmacological agents and adjuvants, (4) describe potential complications associated with lower extremity nerve blocks, and (5) identify informational gaps pertaining to outcomes, which warrant further investigation.

Local Anesthetic-Induced Myotoxicity After Continuous Adductor Canal Block.

Objective: Local anesthetic-induced myotoxicity occurs consistently in animal models, yet is reported rarely in humans. Herein, we describe 3 sentinel cases of local anesthetic myotoxicity after continuous adductor canal block (ACB).

Case Report: Three patients underwent total knee arthroplasty that was managed with subarachnoid block plus ACB induced with 1.

Evidence Basis for Ultrasound Guidance for Lower-Extremity Peripheral Nerve Block: Update 2016.

This article reviews and summarizes randomized controlled studies that have investigated ultrasound guidance (USG) for lower-extremity peripheral nerve blocks in comparison with other peripheral nerve localization techniques and those that compared different ultrasound-guided techniques investigating optimal perineural local anesthetic distribution patterns.Thirty-four studies met the inclusion criteria (minimum Jadad score 3), and 10 additional studies directly compared USG with peripheral nerve stimulation, and 5 additional studies directly compared USG with landmark-based field blocks. Fourteen studies compared different local anesthetic distribution parameters.

The Second American Society of Regional Anesthesia and Pain Medicine Evidence-Based Medicine Assessment of Ultrasound-Guided Regional Anesthesia: Executive Summary.

Objectives: In 2009 and again in 2012, the American Society of Regional Anesthesia and Pain Medicine assembled an expert panel to assess the evidence basis for ultrasound guidance as a nerve localization tool for regional anesthesia.

Methods: The 2012 panel reviewed evidence from the first advisory but focused primarily on new information that had emerged since 2009. A new section was added regarding the accuracy and reliability of ultrasound for determining needle-to-nerve proximity.

Evidence-based medicine for ultrasound-guided regional anesthesia.

Available evidence favoring the use of ultrasound for regional anesthesia is reviewed, updated, and critically assessed. Important outcome advantages include decreased time to block onset; decreased risk of local anesthetic systemic toxicity; and, depending on the outcome definition, increased block success rates. Ultrasound guidance, peripheral nerve blocks, and central neuraxial blocks are discussed.

Peripheral nerve blocks for ambulatory surgery.

Peripheral nerve blocks (PNBs) provide significant improvement in postoperative analgesia and quality of recovery for ambulatory surgery. Use of continuous PNB techniques extend these benefits beyond the limited duration of single-injection PNBs. The use of ultrasound guidance has significantly improved the overall success, efficiency, and has contributed to the increased use of PNBs in the ambulatory setting.

Ultrasound-guided adductor canal block for arthroscopic medial meniscectomy: a randomized, double-blind trial.

Purpose: The saphenous nerve block using a landmark-based approach has shown promise in reducing postoperative pain in patients undergoing arthroscopic medial meniscectomy. We hypothesized that performing an ultrasound-guided adductor canal saphenous block as part of a multimodal analgesic regimen would result in improved analgesia after arthroscopic medial meniscectomy.

Methods: Fifty patients presenting for ambulatory arthroscopic medial meniscectomy under general anesthesia were prospectively randomized to receive an ultrasound-guided adductor canal block with 0.

Evidence basis for regional anesthesia in multidisciplinary fast-track surgical care pathways.

Fast-track programs have been developed with the aim to reduce perioperative surgical stress and facilitate patient's recovery after surgery. Potentially, regional anesthesia and analgesia techniques may offer physiological advantages to support fast-track methodologies in different type of surgeries. The aim of this article was to identify and discuss potential advantages offerred by regional anesthesia and analgesia techniques to fast-track programs.

Ultrasound and review of evidence for lower extremity peripheral nerve blocks.

This qualitative systematic review summarizes existing evidence from randomized controlled trials (RCTs) comparing ultrasound (US) to alternative techniques for lower extremity peripheral nerve block. There were 11 RCTs of sufficient quality for inclusion. Jadad scores ranged from 1 to 4 with a median of 3.

The ASRA evidence-based medicine assessment of ultrasound-guided regional anesthesia and pain medicine: Executive summary.

Objectives: The American Society of Regional Anesthesia and Pain Medicine charged an expert panel to examine the evidence basis for ultrasound guidance as a nerve localization tool in the clinical practices of regional anesthesia and interventional pain medicine.

Methods: The panel searched, examined, and assessed the literature of ultrasound-guided regional anesthesia (UGRA) from the past 20 years. The qualities of studies were graded using the Jadad score.

Anatomic basis to the ultrasound-guided approach for saphenous nerve blockade.

Background And Objectives: Successful blockade of the saphenous nerve using surface landmarks can be challenging. We evaluated the anatomic basis of performing a saphenous nerve block with ultrasound (US) using its relationship to the saphenous branch of descending genicular artery, sartorius muscle, and the adductor hiatus as defined by cadaveric measurements.

Methods: Using a total of 9 cadaveric knee dissections, the saphenous nerve and its relationship to the saphenous branch of the descending genicular artery (SBDGA) were examined.

Concurrent expansion of plasma volume and left ventricular end-diastolic volume in patients after rapid infusion of 5% albumin and lactated Ringer's solution.

Study Objective: To examine the effects of plasma volume expansion on plasma volume, left ventricular end-diastolic volume (LVEDV), and cardiac index (CI) after rapid fluid infusion, as knowledge of the degree of concordance between plasma and cardiac preload expansion could optimize LVEDV expansion without administering excessive fluid.

Design: Randomized, double-blinded study.

Setting: Academic community hospital.

The effect of single-injection femoral nerve block versus continuous femoral nerve block after total knee arthroplasty on hospital length of stay and long-term functional recovery within an established clinical pathway.

Total knee arthroplasty (TKA) may result in severe pain, and single-injection femoral nerve blocks (SFNB) have been demonstrated to have a limited duration of analgesia. Continuous femoral nerve blocks (CFNB) can prolong the analgesic duration of SFNB. We prospectively randomized 36 patients undergoing TKA to CFNB versus SFNB and evaluated the effect on hospital length of stay (LOS) as the primary outcome within a standardized clinical pathway.